A Medicaid reduction? That is not likely

The director of the Center for Medicare and Medicaid Services told Gov. Maggie Hassan in a letter last week that the state could expand Medicaid and then reduce eligibility at any later time. It was an assurance worth only the paper it was printed on.

Last year, governors asked HHS if they could partially expand Medicaid coverage. HHS said no. It was all or nothing. That is because Obamacare does not work without expanded Medicaid eligibility. Does anyone believe that the administration would allow after expansion what it refuses before expansion? Moreover, does anyone believe that the administration would let its signature achievement be hobbled by states scaling back eligibility? At some point, it would move to prevent that.How would it do that? The Affordable Care Act contains a "maintenance of effort" provision that requires states to offer at least the same level of Medicaid services they offered before the law went into effect. A simple revision, passed by Congress, could require that states maintain current levels of service, not 2009 levels. Presto, expansion is cemented in federal law.

And even if allowed, reducing eligibility would be politically difficult. Gov. Hassan herself has accused Republicans of cutting funding for sick and disabled children after they increased funding for services for sick and disabled children. Imagine the political attacks that any proposal to scale back Medicaid eligibility would bring.